Abstract

Background

Non-pharmaceutical public health interventions may provide simple, low-cost, effective
ways of minimising the transmission and impact of acute respiratory infections in
pandemic and non-pandemic contexts. Understanding what influences the uptake of non-pharmaceutical
interventions such as hand and respiratory hygiene, mask wearing and social distancing
could help to inform the development of effective public health advice messages. The
aim of this synthesis was to explore public perceptions of non-pharmaceutical interventions
that aim to reduce the transmission of acute respiratory infections.

Methods

Five online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and Web of Science) were
systematically searched. Reference lists of articles were also examined. We selected
papers that used a qualitative research design to explore perceptions and beliefs
about non-pharmaceutical interventions to reduce transmission of acute respiratory
infections. We excluded papers that only explored how health professionals or children
viewed non-pharmaceutical respiratory infection control. Three authors performed data
extraction and assessment of study quality. Thematic analysis and components of meta-ethnography
were adopted to synthesise findings.

Results

Seventeen articles from 16 studies in 9 countries were identified and reviewed. Seven
key themes were identified: perceived benefits of non-pharmaceutical interventions,
perceived disadvantages of non-pharmaceutical interventions, personal and cultural
beliefs about infection transmission, diagnostic uncertainty in emerging respiratory
infections, perceived vulnerability to infection, anxiety about emerging respiratory
infections and communications about emerging respiratory infections. The synthesis
showed that some aspects of non-pharmaceutical respiratory infection control (particularly
hand and respiratory hygiene) were viewed as familiar and socially responsible actions
to take. There was ambivalence about adopting isolation and personal distancing behaviours
in some contexts due to their perceived adverse impact and potential to attract social
stigma. Common perceived barriers included beliefs about infection transmission, personal
vulnerability to respiratory infection and concerns about self-diagnosis in emerging
respiratory infections.

Conclusions

People actively evaluate non-pharmaceutical interventions in terms of their perceived
necessity, efficacy, acceptability, and feasibility. To enhance uptake, it will be
necessary to address key barriers, such as beliefs about infection transmission, rejection
of personal risk of infection and concern about the potential costs and stigma associated
with some interventions.